Health committee  It would be CIHI. CIHI currently collects all sorts of utilization data. Those include outpatient data; in-patient data; and data on long-term care, residential care, and home care as well.

Health committee  I think they are reluctant to take the information in the different data sets and link it together to demonstrate a cross-continuum picture of care of Canadians. Respectfully, I think there are a lot of policy and privacy implications, but they can be and are addressable within the provinces as well.

Health committee  In the U.K. they've followed a very interesting model in that they've linked physician payments with the collection of patient-reported outcomes data. So physicians are obligated to instruct their patients to collect patient-reported outcomes data pre- and post-surgery, so they are able to understand the brief trajectory of change in a patient's health.

Health committee  That's an excellent question. We could spend an hour talking about it, but I think long-term care is a critically important and growing sector where there are many opportunities to align funding with the objectives you want to achieve. For example, there are initiatives occurring in Ontario and Alberta to line up the funding for long-term care homes based on the acuity, the clinical complexity, and the physical needs of the patients in the long-term care residential home sectors.

Health committee  I think that there are definitely opportunities. However, as I go back to my first recommendation, I think that the national health information agency needs to make and can make short-term strides on implementing standardized data collection in the provinces that are not doing so, because otherwise, you're just pouring more money after more money and you don't know if you're getting good value for that money.

Health committee  Specifically with regard to the Canadian Institute for Health Information, I think that they should be much more proactive in collecting data in the provinces because right now that collection is voluntary in a number of provinces. If those provinces don't have the infrastructure, electronic or physical, the data is not making its way into the system.

Health committee  I believe that activity-based funding is an innovation in Canada. It does not mean that it's an international innovation, as many countries have transitioned to activity-based funding. The United States was first off the mark in the late 1970s, followed by some states in Australia, which since have been followed essentially by all the Nordic countries, France, and England, Ireland, Germany, and Japan.

Health committee  I'll try both of those. To the first point, one of my recommendations, and one that I think is really important, is to start to collect outcome measures and patient-based outcome measures that we can tie these results and these initiatives to. In fact, I'm actually running the only population-based, patient-reported outcome measures, funded by the Canadian Institutes for Health Research, in the Vancouver Coastal Health authority right now.

Health committee  Well, I'd like to come back to the patient-reported outcome measures work, which I think is critically important to the future of our health care system. What we're seeing is that there's only one nation in the world, and that is England, that is currently collecting population-based outcome measures on just a very narrow sliver of supply-sensitive and preference-sensitive care conditions.

Health committee  If we're going to limit the discussion to the experience in B.C., there are several different initiatives within their patient-focused funding there. One of them is the activity-based funding. Another of them is called the procedural care program, which does bulk contracting with hospitals for incremental surgical volume.

Health committee  The British Columbia experiment with activity-based funding is essentially intended to provide more care. It is about decreasing length of stays and decreasing wait-lists. There are no outcome measures in terms of patient-reported outcome measures or patient outcomes, although we are looking at readmission rates and mortality rates to see if we detect changes.

Health committee  I'm sorry, I don't have insight into medical device evaluation.

Health committee  I do know that many of my faculty colleagues do have international collaborations, but it is also hard to know. Having worked in the NIH a little bit as well, with grant funds from there, they actually tend to be a little more insular and have fewer international collaborations.

Health committee  Well, I think the federal wait-times strategy was a very innovative method for trying to get this contracting with activity-based funding down, because now the provinces are very familiar with the mechanism. At the same time, it opens the door for perceived inequities between different kinds of surgeries if you're not in the Cinderella services of the five conditions.

Health committee  Those are very complex issues you're raising there in a very long question. I'll try to knock them off as I can. First off—